Utility of scrape cytology in the diagnosis of ovarian masses

Background: Cytology is a useful adjunct to frozen section for rapid diagnosis of neoplastic pathology. However frozen section facility is available in limited centres. Therefore, we undertook this study to find out role of scrape cytology for diagnosis of ovarian masses.Methods: It is an observational study done in a medical college. One hundred ovarian masses were collected for a period of eighteen months. Cut surface of ovarian masses were scraped with edge of a glass slide. Smears were prepared and stained with H and E stain, examined and a presumptive diagnosis was given. The verification of cytological diagnosis was done by histopathological report. All the data were recorded, tabulated and analyzed with the help of standard statistical methods using Microsoft XL.Results: A total of hundred cases were studied. Left ovary was involved in 38 cases, right ovary in 52 cases and bilateral ovaries in 10 cases. Malignant cases mostly yielded hyper cellular smear. On Chi square test, it was significant with value of less than .001. The overall sensitivity and specificity of scrape cytology in diagnosing ovarian neoplasm, considering HPE as gold standard, are 98% and 78% respectively. In Dysgerminoma, Papillary adenocarcinoma, Mucinous Cystadenoma, Benign cystic teratoma, Granulomatous lesion of ovary, Lymphoma and Mucinous adenocarcinoma, scrape diagnosis corroborated with the histological diagnosis. Notable discrepancy was seen in cases of Endometrioid carcinoma.Conclusions: Scrape cytology can serve as a powerful tool for early diagnosis of ovarian masses in close cooperation of the clinician, radiologist and pathologist. It has a potential for widespread use as knowledge and experience of interpreting cytopathologists increase.

Screening for thalassemia and other hemoglobinopathies in a tertiary care hospital of West Bengal: Implications for population screening.

Hemoglobinopathies are common genetic disorders of hemoglobin, which can be prevented by population screening and offering genetic counseling. In absence of population-based screening for hemoglobinopathies, the hospital-based diagnosis register provide idea about the extent of problem in the community. The present study was undertaken to find out the burden of hemoglobinopathies and spectrum of this disorders among the population who were screened in the hospital-based screening program. A record-basedanalysis of subjects who underwent screening for hemoglobinopathies in Burdwan Medical College and Hospital over a period of 3 years and 4 months revealed that overall 29.3% of subjects were positive for hemoglobinopathies. Beta thalassemia heterozygous was the most commonhemoglobinopathy in this region closely followed by hemoglobin E heterozygous. In view of high prevalence of hemoglobinopathies in this region, a routine premarital screening program is needed for identification and prevention of high-risk marriages.

Differences in the cell wall architecture of melanin lacking and melanin producing Cryptococcus neoformans clinical isolates from India: an electron microscopic study

Cryptococcus neoformans is an important opportunistic fungal pathogen that causes life-threatening infection of the central nervous system. A major virulence factor for C. neoformans is the production of melanin in the cell wall. Using transmission electron microscopy, we studied the cell walls of three pairs of isolates obtained from patients with dual cryptococcal infections, where a melanotic and an albino strain were isolated from the CSF of each patient. Transmission Electron Microscopy revealed that the albino strains lacked a melanin layer whereas a melanin layer was associated with the cell wall of the melanotic strains, comprising approximately 75 percent of the cell wall area. The cell wall size of the melanin producing cells was approximately double the size the albino isolates' cell walls (p value <= 0.003). In this study TEM revealed that the differences in the ultrastructure of the melanin lacking and melanin producing isolates were associated to the cell wall and the melanin layer.

Cryptococcus neoformans é um importante fungo oportunista patogênico que causa infecção no sistema nervoso central, e que pode levar o paciente à morte. Um dos principais fatores de virulência do C. neoformans é a produção de melanina na parede celular. Utilizando microscopia eletrônica de transmissão, nós estudamos as paredes celulares de três pares de isolados obtidos de pacientes com dupla infecção pelo fungo, onde um isolado melanizado e um albino foram isolados do líquor de cada paciente. A microscopia eletrônica de transmissão revelou que as cepas albinas não apresentavam a camada de melanina enquanto que uma camada de melanina estava associada com a parede celular de cepas melanóticas, constituindo aproximadamente 75 por cento da área da parede celular. O tamanho da parede celular das células produtoras de melanina foi aproximadamente o dobro do tamanho da parede celular dos isolados albinos (p < 0,003). Neste estudo, a microscopia eletrônica de transmissão revelou que as diferenças na estrutura dos isolados albinos sem melanina e dos isolados produtores de melanina estava associada à parede celular e a camada de melanina.

Progress in diagnosis of opportunistic infections in HIV/AIDS.

The impact of HIV/AIDS is different in developed and developing countries including India. Limited access to health care facilities, lack of infrastructure for diagnostic set up and cost of anti retroviral therapy are some of the reasons. Early accurate diagnosis of opportunistic infections (OIs), the common presenting symptom of the patients, is the key for success of effective management. This review attempts an overview of few of the important OIs with which majority of Indian patients present in the clinics. Emphasis has been on conventional method of diagnostic approach, which is possible in most of the diagnostic laboratory set up in India. Awareness of the disease and maintenance of high index of clinical suspicion are required. An integrated approach to patient management with active interaction between clinicians and microbiologists would be highly beneficial. Introduction of routine in vitro antimicrobial testing system especially for Candida sp, Cryptococcus sp and Mycobacterium sp, is also important, in order to obtain a baseline data on the susceptibility pattern, which not only have therapeutic relevance, but also can predict in advance, any shift in these patterns in the Indian population. Administrative support for the skill development of personnel, facility for data preservation and telemedicine can extend the diagnostic expertise to the remote areas, without affecting the patients mobility.

Prevalence of Aspergillus species in clinical samples isolated in an Indian tertiary care hospital.

CONTEXT (BACKGROUND): In recent times, it has become important to determine the prevalence of different Aspergillus species in clinical samples in view of difference in antifungal susceptibility noted in some species. AIMS: To determine the species prevalence of Aspergillus isolates in various clinical samples received in the Mycology Laboratory at our institute. METHOD: Over a period of 4-years, a total of 18,731 samples were processed, and species identification carried out by standard microbiological methods. RESULTS: Four hundred and fifty six samples (2.43%) were culture positive for Aspergillus species. A.flavus (46.93%) was the most common isolate, followed by A.fumigatus (37.72%) and A.niger (15.35%). It was observed that A.fumigatus was the predominant species isolated from blood and respiratory specimens, A.flavus was predominantly isolated from nasal polyps whereas A.niger predominated in nail specimens. Culture positivity was highest in the age group 12-65 years and in males. Sixty-nine patients (15.13%) were admitted to the intensive care unit. CONCLUSIONS: The study highlights the diverse manifestations caused by Aspergillus species in human beings and also throws light on the different species prevalent locally. The knowledge would prove useful in selecting empirical antifungal therapy and formulating prophylactic and pre-emptive strategies.

Comparison of trypsin treatment method and standard laboratory technique for diagnosis of dermatomycosis.

Dermatomycosis is prevalent worldwide. Discrepancy between microscopic examination and culture findings can create problems in the diagnosis of this common infection. In this study, samples from 60 patients were processed after trypsin treatment and examined by neutral red staining to distinguish viable and non-viable fungal elements. The trypsin treatment method was compared with standard laboratory techniques. A higher number of direct-microscopy-positive, culture-negative samples were obtained without trypsin treatment. Trypsin treatment increased the isolation of fungi from clinical samples, and neutral red staining was able to distinguish viable fungal elements.